866 - Application for a Protection visabridging visa. Eligibility for a bridging visa is determined...

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Information about your application for a protection visa Application for a protection visa Form 866 PART A Form 866 has 3 parts A Part A (this part) Explanatory notes on how to apply for a protection visa B Part B Application form to identify each person included in this application and family composition C Part C Personal details for each person included in this application A separate Part C must be completed for each person included in this application The Department of Home Affairs (the Department) preferred lodgement method for visas is online through ImmiAccount. Creating an account is quick and easy – visit www.homeaffairs.gov.au/immiaccount/ There are a number of benefits to lodging online through ImmiAccount: you can check the status of your application, continue a saved application, attach documents to an application, update personal details, and access a copy of your online application at any time. Important – Please read this information carefully before you complete your application. Once you have completed your application we strongly advise that you keep a copy for your records. Complete this application form if you: • are in Australia; • are seeking Australia’s protection; and • have your own claims for protection; or • are a member of the same family unit of a person who has claims for protection. You may be granted a protection visa if it is determined that you engage Australia’s protection obligations and you and any members of your family unit included in the application meet all other requirements for the grant of a protection visa under the Migration Act 1958 and the Migration Regulations 1994. Eligibility for a protection visa Depending on your circumstances you may be eligible for a: • permanent Protection (Class XA) visa; • Temporary Protection (Class XD) visa (TPV); • Safe Haven Enterprise (Class XE) visa (SHEV). If you wish to be considered for a SHEV, you must sign the declaration in Question 1 of Part B of this form. Information on protection visas, including eligibility and what each visa allows you to do, is available on the Department’s website www.homeaffairs.gov.au/protectionvisas TPVs and SHEVs are temporary visas. If you hold a TPV or SHEV and wish to apply for another TPV or SHEV, you must apply online at www.homeaffairs.gov.au/immiaccount or complete form 1505 Application for a subsequent Temporary Protection visa or Safe Haven Enterprise visa. Subsequent TPV or SHEV applications lodged on form 866 are invalid and will not be accepted by the Department. A SHEV holder can also apply for a prescribed permanent or temporary onshore substantive visa (except a permanent Protection visa) if, for at least 42 months of the 5 years of the SHEV, they: • were employed in regional Australia and did not receive certain social security benefits; or • were enrolled in full time study in regional Australia; or • a combination of the above. Information on the meaning of ‘regional Australia’, ‘work’ and ‘study’ for the purpose of a SHEV is available on the Department’s website www.homeaffairs.gov.au/protectionvisas Further information on protection visas, including eligibility and what each visa allows you to do, is available on the Department’s website www.homeaffairs.gov.au/protectionvisas Department of Home Affairs 866 (Design date 09/19) - Page 1 © COMMONWEALTH OF AUSTRALIA, 2019

Transcript of 866 - Application for a Protection visabridging visa. Eligibility for a bridging visa is determined...

  • Information about your application for a protection visa

    Application for a protection visaForm

    866

    PARTAForm 866 has 3 parts

    A Part A (this part)– Explanatory notes on how to apply for a protection visa

    B Part B– Application form to identify each person included in this application and family composition

    CPart C– Personal details for each person included in this

    application

    – A separate Part C must be completed for each person included in this application

    The Department of Home Affairs (the Department) preferred lodgement method for visas is online through ImmiAccount. Creating an account is quick and easy – visit www.homeaffairs.gov.au/immiaccount/

    There are a number of benefits to lodging online through ImmiAccount: you can check the status of your application, continue a saved application, attach documents to an application, update personal details, and access a copy of your online application at any time.

    Important – Please read this information carefully before you complete your application. Once you have completed your application we strongly advise that you keep a copy for your records.

    Complete this application form if you:

    • are in Australia;

    • are seeking Australia’s protection; and

    • have your own claims for protection; or

    • are a member of the same family unit of a person who has claims for protection.

    You may be granted a protection visa if it is determined that you engage Australia’s protection obligations and you and any members of your family unit included in the application meet all other requirements for the grant of a protection visa under the Migration Act 1958 and the Migration Regulations 1994.

    Eligibility for a protection visaDepending on your circumstances you may be eligible for a:

    • permanent Protection (Class XA) visa;

    • Temporary Protection (Class XD) visa (TPV);

    • Safe Haven Enterprise (Class XE) visa (SHEV).

    If you wish to be considered for a SHEV, you must sign the declaration in Question 1 of Part B of this form.

    Information on protection visas, including eligibility and what each visa allows you to do, is available on the Department’s website www.homeaffairs.gov.au/protectionvisas

    TPVs and SHEVs are temporary visas. If you hold a TPV or SHEV and wish to apply for another TPV or SHEV, you must apply online at www.homeaffairs.gov.au/immiaccount or complete form 1505 Application for a subsequent Temporary Protection visa or Safe Haven Enterprise visa. Subsequent TPV or SHEV applications lodged on form 866 are invalid and will not be accepted by the Department.

    A SHEV holder can also apply for a prescribed permanent or temporary onshore substantive visa (except a permanent Protection visa) if, for at least 42 months of the 5 years of the SHEV, they:

    • were employed in regional Australia and did not receive certain social security benefits; or

    • were enrolled in full time study in regional Australia; or

    • a combination of the above.

    Information on the meaning of ‘regional Australia’, ‘work’ and ‘study’ for the purpose of a SHEV is available on the Department’s website www.homeaffairs.gov.au/protectionvisas

    Further information on protection visas, including eligibility and what each visa allows you to do, is available on the Department’s website www.homeaffairs.gov.au/protectionvisas

    Department of Home Affairs

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  • Application barsIf you:

    • entered Australia without a valid visa and/or you were not immigration cleared (as an offshore entry person or an unauthorised maritime arrival or unauthorised air arrival); or

    • have been refused a protection visa since your last arrival to Australia; or

    • have had a protection visa cancelled since your last arrival to Australia; or

    • are a national of 2 or more countries; or

    • have protection in a prescribed safe third country; or

    • have ever held a Temporary Safe Haven (Class UJ) visa;

    you will be prevented from making a valid protection visa application unless you have been notified that the Minister has lifted any application bar. The Minister has the power to lift any application bar if it is determined to be in the public interest. If you are affected by any application bar you will be advised.

    Further information on application bars and the Minister’s guidelines for lifting them is available on the Department’s website www.homeaffairs.gov.au/protectionvisas

    To make a valid applicationThe Department’s preferred lodgment method is online. You can lodge this application online through your ImmiAccount at www.homeaffairs.gov.au/immiaccount

    To make a valid application you must:

    • pay the visa application charge electronically through the ‘My Payments’ section of ImmiAccount. Sign into, or create, your ImmiAccount and select My Payments>Manage Payments>Pre-Pay Paper Service, at www.homeaffairs.gov.au/immiaccount;

    • be in Australia;

    • provide your residential address;

    • provide personal identifiers (eg. digital photograph and fingerprints);

    • not be prevented from lodging an application because of any application bars; and

    • complete this form and put forward reasons for claiming protection or be a member of the family unit of someone who is claiming protection.

    Note: If you have not previously provided personal identifiers (biometrics) you will need to have them collected at an office of the Department. You will be sent information on what you need to do and when to have them collected. If you fail to comply with a request by the Department for personal identifier/biometrics collection, your application will become invalid.

    Your immigration statusAs an applicant for a protection visa you may be eligible for a bridging visa. Eligibility for a bridging visa is determined primarily by the applicant’s immigration status at the time of lodging the protection visa application. Depending on your circumstances you may also be eligible for permission to work on a bridging visa. A bridging visa will give you lawful status in Australia. Further information about bridging visas is available on the Department’s website www.homeaffairs.gov.au

    If you hold a valid visa you should lodge your protection visa application before your current visa expires. If your current visa expires, and you have not lodged a valid application, you will become unlawful in Australia. If you become unlawful you may be detained.

    Deciding if you should apply for a protection visaIf you apply for protection and you are refused, it is unlikely that you will be able to apply for another visa while still in Australia.

    If you are not a person to whom Australia has protection obligations, there may be other visas more suitable to your circumstances. More information on finding the right visa for you is available on the Department’s website www.homeaffairs.gov.au

    Further information on Australia’s protection obligations is available on the Department’s website www.homeaffairs.gov.au/protectionvisas

    Evidence and supporting documentsYou should provide with your application certified copies of:

    • any documents/evidence that you think will support your claim for protection;

    • all pages of passports and other travel documents held by all persons in the application, including the documents you used to enter Australia; and

    • any documents/evidence to support the relationship between each person in the application (eg. birth certificates, notarial certificates, marriage certificates, financial documents and undertakings for de facto relationships, financial documents to evidence that dependants over the age of 18 are dependent on you, and any other evidence to support relationships between each applicant).

    Original documents that you have provided with your application will be returned to you, while the certified copies will be retained by the Department.

    Documents in a language other than English should be accompanied by an English translation completed by a translator accredited by the National Accreditation Authority for Translators and Interpreters (NAATI).

    All claims for protection and supporting documentation and evidence should be provided when you lodge this application. A decision may be made on the information provided in your written application and you may not be given another opportunity to present these claims.

    Who can certify my documents?For a full list of people who can certify documents/photographs please see the Statutory Declarations Regulations 1993, available from the Attorney-General’s website www.ag.gov.au

    Members of the family unitA member of the family unit of someone making claims for protection can include a partner, dependent children and certain other dependants.

    Members of the family unit may apply together on the same form and must all be in Australia at the time of application.

    If a child is born to an applicant after an application is lodged and before a decision is made on that application by the Department, the child will be taken to be included in that application. You should promptly notify the Department of the birth of your child by sending a certified copy of their birth certificate.

    More information on who is a member of the family unit can be found on form 1497i Including family members in your refugee, humanitarian or protection visa application. Form 1497i is available from the Department’s website www.homeaffairs.gov.au/allforms

    Help with your applicationInformation on getting help for your application is available on the Department’s website www.homeaffairs.gov.au/protectionvisas

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  • Immigration assistanceMigration agents or exempt persons can give immigration assistance. You can access information about migration agents and exempt persons on the Department’s website www.homeaffairs.gov.au

    Appointing a migration agent/exempt personTo appoint a migration agent/exempt person you should complete Options for receiving written communications in Part B of this form.

    Your migration agent/exempt person should complete form 956 Advice by a registered migration agent/exempt person of providing immigration assistance.

    Form 956 is available from the Department’s website www.homeaffairs.gov.au/allforms

    Warning: Some visa applicants have been victims of scams, paying large sums of money to fraudulent immigration advisors who promise guaranteed visas.

    No one can guarantee that you will receive a protection visa, or the timeframe in which your application will be processed.

    Options for receiving written communicationsIf you do not appoint a migration agent/exempt person you may still authorise another person, in writing, to receive written communications on your behalf. This person is called the authorised recipient.

    Authorised recipient informationAll written communication about your application will be sent to your authorised recipient, unless you indicate that you wish to have health and/or character information sent directly to you.

    The Department will communicate with the most recently appointed authorised recipient as you may only appoint one authorised recipient at any time for a particular application.

    You will be taken to have received any documents sent to that person as if they had been sent to you.

    To appoint an authorised recipient you should complete:

    • Options for receiving written communications in Part B of this form; and

    • form 956A Appointment or withdrawal of an authorised recipient.

    Note: Migration agents/exempt persons do not need to complete form 956A.

    Form 956A is available from the Department’s website www.homeaffairs.gov.au/allforms

    Consent to communicate electronicallyThe Department may use a range of means to communicate with you. However, electronic means such as fax or email will only be used if you indicate your agreement to receiving communication in this way.

    To process your application the Department may need to communicate with you about sensitive information, for example, health, police checks, financial viability and personal relationships. Electronic communications, unless adequately encrypted, are not secure and may be viewed by others or interfered with.

    If you agree to the Department communicating with you by electronic means, the details you provide will only be used by the Department for the purpose for which you have provided them, unless there is a legal obligation or necessity to use them for another purpose, or you have consented to use for another purpose. They will not be added to any mailing list.

    The Australian Government accepts no responsibility for the security or integrity of any information sent to the Department over the internet or by other electronic means.

    If you authorise another person to receive documents on your behalf and they wish to be contacted electronically, their signature is required on form 956 or 956A to indicate their consent to this form of communication.

    Note: Electronic communication is the fastest means of communication available and the Department prefers to communicate electronically.

    Important information about privacyYour personal information is protected by law, including the Privacy Act 1988. Important information about the collection, use and disclosure (to other agencies and third parties, including overseas entities) of your personal information, including sensitive information, is contained in form 1442i Privacy notice. Form 1442i is available from the Department’s website www.homeaffairs.gov.au/allforms or offices of the Department. You should ensure that you read and understand form 1442i before completing this form.

    SHEV applicants If you are granted a SHEV and later make a valid application for a further prescribed visa, the Department may disclose your personal information to the Department of Human Services, the Department of Social Services, the Department of Education and Training, and other government agencies and third parties where required, in order to determine whether you meet the requirements for making a valid application for the prescribed visa.

    Accessing your personal informationUnder the Freedom of Information Act 1982 you or someone authorised to access information on your behalf, can apply for access to documents containing personal information. There is no fee for accessing your own information. If you are overseas, you must provide an address in Australia to which copies of documents or other records can be sent. More information on how to make a request under the Freedom of Information Act 1982 is given on form 424A Request for access to documents and/or information.

    Note: Information you have submitted online can be accessed via your ImmiAccount.

    How to lodge your applicationThe Department’s preferred lodgment method is online through ImmiAccount. Creating an account and applying online is quick and easy – visit www.homeaffairs.gov.au/immiaccount/

    You can also lodge this application form by post. Send your completed application form and supporting evidence to:

    Onshore Protection New South Wales Department of Home Affairs GPO Box 9984 Sydney NSW 2001

    Further information on how to lodge your application is available on the Department’s website www.homeaffairs.gov.au

    Note: Application forms cannot be lodged in person at, or hand delivered to, any office of the Department.

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  • Please keep these information pages for your reference

    Application checklistUse this checklist before you lodge your application.

    Have you answered all questions in Part B?

    In Question 1 of Part B, if applying for a SHEV, have you signed the Declaration of intention to work and/or study in regional Australia?

    In Question 2 of Part B, have you listed all the members of your family unit who are to be included in this application?

    A separate Part C must be completed for each person included in this application

    Has each person who is included in this application completed a separate Part C and answered all questions?

    In Question 86 of Part C, has each person aged 18 years or over who is included in this application signed the Australian Values Statement?

    In Question 87 of Part C, has each person who is included in this application signed the Declaration?

    If you have attached sheets of paper to this application which give additional information, have you stated the part and question number to which the information relates, and signed each additional sheet for each applicant?

    If you are registered and have been assessed by the United Nations High Commissioner for Refugees (UNHCR), have you completed and attached the UNHCR consent form which provides the Department with consent to speak to the UNHCR about your application?

    The UNHCR consent form is available from the Department’s website www.homeaffairs.gov.au/protectionvisas

    Have you provided certified copies of all pages of passports and other travel documents held by all persons included in this application, including the documents they used to enter Australia? If these documents are not in English have you provided translated copies?

    Have you provided certified copies of birth or notarial certificates for each person included in this application, and marriage certificates or other evidence of the relationship between each person in this application? If these documents are not in English have you provided translated copies?

    Have you provided any additional documents which support your application?If these documents are not in English have you provided translated copies?

    Have you listed documents which are attached to your application and/or which you will provide separately?

    If you have not provided documents, have you explained why?

    If applicable, has your interpreter filled the interpreter details section in Part B?

    If applicable, has your migration agent filled in and lodged form 956 Advice by a registered migration agent/exempt person of providing immigration assistance?

    If applicable, have you filled in and lodged form 956A Appointment or withdrawal of authorised recipient?

    Have you provided evidence of payment of the application fee?

    Have you provided reasons for applying for protection?

    Have you provided your residential address?

    Do you need further information?This is a general guide to completing your application. Information given on this form is based on the Migration Act 1958 and Migration Regulations 1994 as they apply at the time this form was printed.

    Home page www.homeaffairs.gov.auGeneral

    enquiry lineTelephone 131 881 during business hours in Australia to speak to an operator (recorded information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.

    ImmiAccount www.homeaffairs.gov.au/immiaccountFor online lodgements and to update your personal information.

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  • Please open this form using Adobe Acrobat Reader. Either type (in English) in the fields provided or print this form and complete it (in English) using a pen and BLOCK LETTERS.

    Tick where applicable 3

    You must answer ALL questions. If any question is not applicable, write ‘N/A’. Failure to do so may lead to your application being considered invalid.

    If you need more space to answer any questions, attach a sheet of paper giving the required details and include the part (Part B) and question number to which the information refers.

    Note: This form is to be used for permanent Protection visa and initial TPV and SHEV applications. When lodged, this application will be taken to be an application for only one of these classes of visa, depending on your eligibility as outlined on the Department’s website www.homeaffairs.gov.au/protectionvisas

    Declaration of intention to work and/or study in regional AustraliaNote: This declaration must be completed for SHEV applications only.

    1 You must indicate in writing that you, or one or more member(s) of the same family unit included in this application, intend to work or study while accessing minimal social security benefits in regional Australia to lodge a valid application for a Class XE subclass 790 (Safe Haven Enterprise) visa. Please sign this declaration before lodging your application.

    You must sign this declaration if you are aged 18 years or over. A parent or legal guardian must sign on behalf of any applicant who is under 15 years of age, or who lacks the legal capacity to sign on their own behalf (applicants who are 15 years of age or older, but have not yet turned 18, may sign for themselves or have a parent or legal guardian sign on their behalf).

    WARNING: Giving false or misleading information is a serious offence.

    Declaration

    • I understand which areas of Australia are designated as regional Australia.

    • I understand that it is my responsibility to find work or study opportunities in regional Australia.

    • I, or a member of the same family unit as me and who is also an applicant for a SHEV, intends to work or study in regional Australia while accessing minimum social security benefits.

    Your name

    Your signature-

    Date

    Day Month Year

    Persons included in this applicationand family compositionB

    Application for a protection visaForm

    866

    PART

    Department of Home Affairs

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  • Details of persons included in this application

    2 Give details of ALL persons included in this application (those seeking Australia’s protection and those who are ‘members of the same family unit’. Members of the same family unit include partner (spouse or de facto), dependent children and other dependants).

    These persons must be in Australia at the time of application.

    Applicant 1 should be the person you want the Department to contact about this application (although you may wish to authorise another person or your migration agent to receive written communications, see Question 9).

    Applicant number Family name Given names

    Date of birthRelationship to applicant 1* (eg. mother, father, partner,

    son, daughter)

    Applicant raising their own claims for protection? ** Day Month Year

    1 N/A No Yes

    2 No Yes

    3 No Yes

    4 No Yes

    5 No Yes

    6 No Yes

    7 No Yes

    8 No Yes

    * Members of the same family unit must attach evidence of their relationship to applicant 1 ** Each applicant who is raising their own claims for protection must complete Questions 75 to 83 when they complete Part C If insufficient space, attach additional details

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  • Character

    3 Has any person named in Question 2 ever:

    • been charged with any offence that is currently awaiting legal action? No Yes

    • been convicted of an offence in any country (including any conviction which is now removed from official records)? No Yes

    • been the subject of an arrest warrant or Interpol notice? No Yes

    • been found guilty of a sexually based offence involving a child (including where no conviction was recorded)? No Yes

    • been named on a sex offender register? No Yes

    • been acquitted of any offence on the grounds of unsoundness of mind or insanity? No Yes

    • been found by a court not fit to plead? No Yes

    • been directly or indirectly involved in, or associated with, activities which would represent a risk to national security in Australia or any other country? No Yes

    • been charged with, or indicted for: genocide, war crimes, crimes against humanity, torture, slavery, or any other crime that is otherwise of a serious international concern? No Yes

    • been associated with a person, group or organisation that has been/is involved in criminal conduct? No Yes

    • been associated with an organisation engaged in violence or engaged in acts of violence (including war, insurgency, freedom fighting, terrorism, protest) either overseas or in Australia? No Yes

    • served in a military force, police force, state sponsored/private militia or intelligence agency (including secret police)? No Yes

    • undergone any military/paramilitary training, been trained in weapons/explosives or in the manufacture of chemical/biological products? No Yes

    • been involved in people smuggling or people trafficking offences? No Yes

    • been removed, deported or excluded from any country (including Australia)? No Yes

    • overstayed a visa in any country (including Australia)? No Yes

    • had any outstanding debts to the Australian Government or any public authority in Australia? No Yes

    If you answered ‘Yes’ to any of the above questions, provide all the relevant details. If the matter relates to a criminal conviction, please provide the nature of the offence, full details of sentence and dates of any period of imprisonment or other detention at Question 73 of Part C.

    Applicant number Details

    If insufficient space, attach additional details

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  • Members of the same family unit NOT included in this applicationMembers of the same family unit include partner (spouse or de facto partner), dependent children and other dependants

    4 Are there any members of the same family unit who are IN AUSTRALIA or overseas but are NOT included in this application?

    No

    Yes Give details

    1. Family name

    Given names

    Date of birth

    Day Month Year

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Place of birth (including town/city, province/state, country)

    Citizenship

    Relationship status

    Married Separated Never married or been in a de facto

    relationshipEngaged Divorced De facto Widowed

    Relationship to applicant 1

    Contact details

    Address

    Postcode

    Mobile/cell

    Telephone (Area code )

    Email address

    Is this member of the same family unit IN AUSTRALIA?

    No Country of residence

    Yes Reason for not including in this application

    2. Family name

    Given names

    Date of birth

    Day Month Year

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Place of birth (including town/city, province/state, country)

    Citizenship

    Relationship status

    Married Separated Never married or been in a de facto

    relationshipEngaged Divorced De facto Widowed

    Relationship to applicant 1

    Contact details

    Address

    Postcode

    Mobile/cell

    Telephone (Area code )

    Email address

    Is this member of the same family unit IN AUSTRALIA?

    No Country of residence

    Yes Reason for not including in this application

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  • 3. Family name

    Given names

    Date of birth

    Day Month Year

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Place of birth (including town/city, province/state, country)

    Citizenship

    Relationship status

    Married Separated Never married or been in a de facto

    relationshipEngaged Divorced De facto Widowed

    Relationship to applicant 1

    Contact details

    Address

    Postcode

    Mobile/cell

    Telephone (Area code )

    Email address

    Is this member of the same family unit IN AUSTRALIA?

    No Country of residence

    Yes Reason for not including in this application

    4. Family name

    Given names

    Date of birth

    Day Month Year

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Place of birth (including town/city, province/state, country)

    Citizenship

    Relationship status

    Married Separated Never married or been in a de facto

    relationshipEngaged Divorced De facto Widowed

    Relationship to applicant 1

    Contact details

    Address

    Postcode

    Mobile/cell

    Telephone (Area code )

    Email address

    Is this member of the same family unit IN AUSTRALIA?

    No Country of residence

    Yes Reason for not including in this application

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  • 5. Family name

    Given names

    Date of birth

    Day Month Year

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Place of birth (including town/city, province/state, country)

    Citizenship

    Relationship status

    Married Separated Never married or been in a de facto

    relationshipEngaged Divorced De facto Widowed

    Relationship to applicant 1

    Contact details

    Address

    Postcode

    Mobile/cell

    Telephone (Area code )

    Email address

    Is this member of the same family unit IN AUSTRALIA?

    No Country of residence

    Yes Reason for not including in this application

    6. Family name

    Given names

    Date of birth

    Day Month Year

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Place of birth (including town/city, province/state, country)

    Citizenship

    Relationship status

    Married Separated Never married or been in a de facto

    relationshipEngaged Divorced De facto Widowed

    Relationship to applicant 1

    Contact details

    Address

    Postcode

    Mobile/cell

    Telephone (Area code )

    Email address

    Is this member of the same family unit IN AUSTRALIA?

    No Country of residence

    Yes Reason for not including in this application

    If insufficient space, attach additional details

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  • Assistance with this form

    5 Did you receive assistance in completing this form?No Go to Question 9

    Yes Please give details of the person who assisted you

    Title: Mr Mrs Miss Ms Other

    Family name

    Given names

    Address

    Postcode

    Telephone number or daytime contact

    Office hours ( ) ( )

    Country code Area code Number

    Mobile/cell

    6 Is the person an agent registered with the Office of the Migration Agents Registration Authority (Office of the MARA)?

    No

    Yes Go to Question 9

    7 Is the person/agent in Australia?No Go to Question 9

    Yes

    8 Did you pay the person/agent and/or give a gift for this assistance?No

    Yes

    Options for receiving written communications

    For more information refer to Part A

    9 All written communications about this application should be sent to: (Tick one box only)

    Myself

    OR

    Authorised recipient

    OR

    You should complete form 956A Appointment or withdrawal of an authorised recipient

    Migration agent

    OR

    Exempt person

    Your migration agent/exempt person should complete form 956 Advice by a registered migration agent/exempt person of providing immigration assistance

    Payment details

    10 Method of paymentMake your payment electronically through the ‘My Payments’ section of ImmiAccount. Sign into, or create, your ImmiAccount and select My Payments>Manage Payments>Pre-Pay Paper Service, at www.homeaffairs.gov.au/immiaccount

    Do not provide credit card details on this form. Make your credit card payment electronically through the ‘My Payments’ section of ImmiAccount.

    Payment receipt number from the ‘My Payments’ section of ImmiAccount

    Attach a copy of your printed receipt.

    Interpreter’s details

    11 Did you receive assistance from an interpreter to complete this application?

    No Go to Part C

    Yes Give details

    Full name of interpreter

    Business address of interpreter

    Postcode

    Interpreter number

    Interpreter agency

    12 Were your statement and other information read back to you in your own language?

    No

    Yes

    Once you have completed this part of the application form, each person included in this application must complete a separate Part C.

    866 (Design date 09/19) - Page 11© COMMONWEALTH OF AUSTRALIA, 2019

    http://www.homeaffairs.gov.au/immiaccount

  • This page is intentionally blank

  • Please open this form using Adobe Acrobat Reader. Either type (in English) in the fields provided or print this form and complete it (in English) using a pen and BLOCK LETTERS.

    Tick where applicable 3

    You must answer ALL questions. If any question is not applicable, write ‘N/A’. Failure to do so may lead to your application being considered invalid.

    If you need more space to answer any questions, attach a sheet of paper giving the required details and include the part (Part C) and question number to which the information refers.

    It is important that you include all details as a decision may be taken based on the information provided in your application only.

    Note: A separate Part C must be completed for each person included in this application (ie. each person named in Question 2 of Part B). Part C is available as a separate document on the Department’s website www.homeaffairs.gov.au/allforms

    Visa eligibility

    1 Did you arrive in Australia with a valid visa?No You will only be considered for a TPV or SHEV

    Go to Question 3

    Yes

    2 When you arrived in Australia with a valid visa, were you immigration cleared and allowed entry at the border?

    No You will only be considered for a TPV or SHEV

    Yes You will be considered for a Permanent Protection visa

    Don’t know

    Note: To be considered for a SHEV you need to complete the Declaration in Question 1 of Part B.

    3 Have you previously made an application for a protection visa in Australia which was refused?

    No

    Yes

    4 Have you previously held a protection visa in Australia which was cancelled?

    No

    Yes

    Application for a protection visaForm

    866

    PARTC Personal details for each person included in this applicationDetails of applicant

    5 What is your full name?Family name

    Given names

    Applicant number (as shown in Question 2 of Part B)

    6 Have you ever been known by other names (including name at birth, name before or after marriage, adoptive or foster name, alias or pseudonym, cultural or tribal name or clan, preferred name, other spellings of name, other ways you write your name)?

    No

    Yes Give details

    Type of name

    Family name

    Given names

    Reason for name change and date (if applicable)

    7 Are you of Russian descent?No

    Yes Write in English your patronymic name

    8 Boat identification number (if applicable)

    9 Sex Male Female Indeterminate /

    Intersex / Unspecified

    Department of Home Affairs

    866 (Design date 09/19) - Page 13© COMMONWEALTH OF AUSTRALIA, 2019

    http://www.homeaffairs.gov.au/allforms

  • 10 If you are female, are you pregnant?N/A

    No

    Yes When is the expected birth date of the child?Day Month Year

    11 Date of birth Day Month Year

    and age years

    12 Have you ever had a different date of birth to the one shown at Question 11?

    No

    Yes Different date of birthDay Month Year

    13 Place of birth

    Town/city

    Province/state

    Country

    14 Your citizenship at birth (if none, write ‘stateless’)

    15 Your current citizenship (if different to at birth)

    Date acquired

    Day Month Year

    16 If you are stateless, how, when and why did you become stateless?Note: A stateless person is not a national or a citizen of any country.

    17 Your father’s citizenship

    18 Your mother’s citizenship

    19 Are you currently a citizen or national of any other country?No

    Yes Give details

    1. Country

    How did you acquire this citizenship or become a national of this country?

    2. Country

    How did you acquire this citizenship or become a national of this country?

    If insufficient space, attach additional details

    20 Have you previously been a citizen or national of any other country?No

    Yes Give details

    Country

    How did you acquire this citizenship or become a national of this country?

    When did you have this citizenship?

    From

    Day Month Year

    to

    Day Month Year

    21 Have you ever been refused, renounced or rescinded citizenship of any country?

    No

    Yes Give details

    1. Date

    Day Month Year

    Country

    Circumstances

    2. Date

    Day Month Year

    Country

    Circumstances

    If insufficient space, attach additional details866 (Design date 09/19) - Page 14 © COMMONWEALTH OF AUSTRALIA, 2019

  • 22 Do you have the right to enter or reside in, whether temporarily or permanently, any country/countries other than your country/countries of nationality or former habitual residence?

    No

    Yes Give details

    1. Country

    How did you acquire the right to enter and reside in this country?

    2. Country

    How did you acquire the right to enter and reside in this country?

    If insufficient space, attach additional details

    23 Do you receive or are you entitled to a pension or any regular income from any country?

    No

    Yes Give details

    24 Have you undertaken any military service? Military service includes compulsory, voluntary, conscription, professional, military training.

    No

    Yes Give details

    1. Military service was: Compulsory Non-compulsory

    Date from

    Day Month Year

    to

    Day Month Year

    Country of service

    Roles/duties

    Unit, battalion, brigade, rank

    Country of deployment

    2. Military service was: Compulsory Non-compulsory

    Date from

    Day Month Year

    to

    Day Month Year

    Country of service

    Roles/duties

    Unit, battalion, brigade, rank

    Country of deployment

    If insufficient space, attach additional details

    25 Do you still have military service obligations in your home country?No

    Yes Give details

    26 Which languages do you speak, read or write (including English)?Language/dialect in order of preference Speak Read Write

    27 If you are called for an interview, will you need an interpreter?No

    Yes In which language and dialect?

    28 If you are called for an interview, are there any factors we need to consider (such as access for a disabled person)?

    No

    Yes Give details

    29 Ethnic group you belong to

    30 Your religion (including denomination eg. Shia Muslim) (if any)

    31 Your occupation

    866 (Design date 09/19) - Page 15© COMMONWEALTH OF AUSTRALIA, 2019

  • 32 Your relationship status (tick all that apply)Attach details if you have been in more than one type of relationship

    Never married or been in a

    de facto relationship

    Engaged Date relationship beganDay Month Year

    Date of intended marriageDay Month Year

    Place of intended marriage

    Married Date relationship beganDay Month Year

    Date of marriageDay Month Year

    Place of marriage

    De facto Date relationship beganDay Month Year

    Place where relationship began

    Separated Date relationship beganDay Month Year

    Date of separationDay Month Year

    Place of separation

    Divorced Date relationship beganDay Month Year

    Date of marriageDay Month Year

    Date of divorceDay Month Year

    Place of divorce

    Widowed Date relationship beganDay Month Year

    Date became widowedDay Month Year

    33 Are you under 18 years of age?No

    Yes Give details of the persons who have legal custody of you or any other persons, not included in this application, who have custodial access or guardianship responsibility of you

    NameDate of birth

    Day Month Year

    34 Your current residential address in AustraliaNote: A post office box address is not acceptable as a residential address. Failure to give a residential address will result in your application being invalid.

    Postcode

    35 Your current postal address in Australia (if the same as residential address, please write ‘same as residential’)

    Postcode

    36 Your telephone numbers

    Office hours (Area code )

    After hours (Area code )

    Mobile/cell

    37 Do you have any email addresses?Note: Include all personal, student and work email addresses. Do not include migration agent email addresses.

    No

    Yes Provide all of your email addresses

    38 Do you agree to the Department communicating with you via email?Yes Email address

    No

    Note: Electronic communication is the Department’s preferred method of communication.

    866 (Design date 09/19) - Page 16 © COMMONWEALTH OF AUSTRALIA, 2019

  • Other family members NOT included in Part B

    39 Give details of other family members who are in Australia or overseas, and have not been included in Part BThis includes:

    • partners (spouse or de facto) – if widowed you must give details of your deceased partner;

    • children – biological or adopted, children from current or previous marriage, all step-children and deceased children;

    • parents – include biological parents, adopted parents, step parents, legal guardians and deceased parents;

    • siblings – include full, half, adopted and step bothers, step sisters and deceased siblings.

    Relationship to you Family name Given names Any other names

    SexDate of birth Chinese commercial code

    (if applicable)

    Place of birth (including town/city, state/province/region, country)

    CitizenshipCurrent residence

    (including town/city, state/province/region, country)

    Indeterminate/ Intersex/ Male Female Unspecified Day Month Year

    If insufficient space, attach additional details

    1 Sex Male

    Female

    Indeterminate / Intersex / Unspecified

    © COMMONWEALTH OF AUSTRALIA, 2019 866 (Design date 09/19) - Page 17

  • 40 Give details of other family members – nieces, nephews, cousins, in-laws, grandparents etc., who travelled with you, or who reside in Australia and with whom you are in contact

    Relationship to you Family name Given names Any other names

    SexDate of birth Chinese commercial code

    (if applicable)

    Place of birth (including town/city, state/province/region, country)

    CitizenshipCurrent residence

    (including town/city, state/province/region, country)

    Indeterminate/ Intersex/ Male Female Unspecified Day Month Year

    If insufficient space, attach additional details866 (Design date 09/19) - Page 18 © COMMONWEALTH OF AUSTRALIA, 2019

  • 41 Are you in contact with relatives outside of Australia?No

    Yes Give details about how you contact them, how often and where they are currently residing

    42 Do you have any personal contacts in Australia?Personal contacts may include friends, other family members and acquaintances in Australia.

    No

    Yes Give details

    1. Family name

    Given names

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Relationship to you (eg. friend)

    Date of birth

    Day Month Year

    Town/city of birth

    State/province/region of birth

    Country of birth

    Nationality

    Your personal contact’s current residential address (including building/unit/house number and street name) Note: A post office box is not acceptable.

    Suburb and town/city

    State or territory Postcode

    Telephone numbers

    Office hours (Area code )

    Mobile/cell

    Email address

    2. Family name

    Given names

    Sex Male Female Indeterminate /

    Intersex / Unspecified

    Relationship to you (eg. friend)

    Date of birth

    Day Month Year

    Town/city of birth

    State/province/region of birth

    Country of birth

    Nationality

    Your personal contact’s current residential address (including building/unit/house number and street name) Note: A post office box is not acceptable.

    Suburb and town/city

    State or territory Postcode

    Telephone numbers

    Office hours (Area code )

    Mobile/cell

    Email address

    If insufficient space, attach additional details

    866 (Design date 09/19) - Page 19© COMMONWEALTH OF AUSTRALIA, 2019

  • Travel to Australia and travel documents

    43 Date of last arrival in Australia Day Month Year

    44 Place of last arrival in Australia (town/city or port)

    45 Date of departure from your home country Day Month Year

    46 Place of departure from your home country (airport or port)

    47 How did you leave your home country?Legally Give details of the travel document you used to depart

    your home country

    Type of document (eg. passport)

    Document number

    Country of issue

    Date of issue

    Day Month Year

    Date of expiry

    Issuing authority/Place of issue as shown in your passport/document

    Illegally Describe how you departed your home country, including the details of any fraudulent documents you used to depart

    If insufficient space, attach additional details

    48 Did you enter Australia as a Visitor

    Transit passenger

    Student

    Migrant

    Ship deserter

    Stowaway

    Unauthorised maritime arrival

    Unauthorised air arrival

    Other Describe

    49 Give details of the travel document you used to enter AustraliaSame travel

    document as that used to

    depart home country

    Other travel document

    Give details

    Type of document (eg. passport)

    Document number

    Country of issue

    Name on document

    Date of issue

    Day Month Year

    Date of expiry

    Issuing authority/Place of issue as shown in your passport/document

    Where is this document?

    Did not enter using a travel

    document

    Give details of why you did not enter using a travel document

    866 (Design date 09/19) - Page 20 © COMMONWEALTH OF AUSTRALIA, 2019

  • 50 Give details of your current travel documentSame travel

    document as that used to

    depart home country

    Same travel document as that used to

    enter Australia

    Other travel document

    Give details

    Type of document (eg. passport)

    Document number

    Country of issue

    Name on document

    Date of issue

    Day Month Year

    Date of expiry

    Issuing authority/Place of issue as shown in your passport/document

    Do not have a current travel

    document

    Give details of why you don’t have a current travel document

    Go to Question 55

    51 Is your current travel document valid for return to your home country?No Why not?

    Yes

    52 How did you obtain your current travel document in your home country?

    53 Has your current travel document been extended by the authorities of your home country?

    No

    Yes Date extendedDay Month Year

    to

    Day Month Year

    City/country where your travel document was extended

    54 Do you have any other current travel documents?No

    Yes Give details

    Type of document (eg. passport)

    Document number

    Country of issue

    Name on document

    Date of issue

    Day Month Year

    Date of expiry

    Issuing authority/Place of issue as shown in your document

    Where is the document now?

    55 Have you ever had, or used, any other travel document (including expired, lost or stolen documents)?

    No

    Yes Provide as much information as possible

    Type of document (eg. passport)

    Document number

    Country of issue

    Name on document

    Where is it now/what happened to it?

    56 Do you ever use a Chinese Commercial Code Number for your names shown in your travel document(s)?

    No

    Yes Chinese Commercial Code Number (in full)

    866 (Design date 09/19) - Page 21© COMMONWEALTH OF AUSTRALIA, 2019

  • Visa and travel history

    57 Have you previously undertaken a health examination for an Australian visa process?

    No

    Yes Give details (including HAP ID if available)

    58 Have you ever applied to enter any country other than Australia?No

    Yes Give details

    To which country?

    Date of application

    Day Month Year

    Where did you apply (including city/country)?

    What reason(s) did you give for wanting to enter?

    What was the outcome of your application?

    59 Have you ever been refused a visa to any country other than Australia?No

    Yes Give details

    1. Date of refusal

    Day Month Year

    Country

    Circumstances

    2. Date of refusal

    Day Month Year

    Country

    Circumstances

    If insufficient space, attach additional details

    60 Have you ever been excluded, asked to leave, deported or removed from any country?

    No

    Yes Give details

    1. Date

    Day Month Year

    Country

    Circumstances

    2. Date

    Day Month Year

    Country

    Circumstances

    If insufficient space, attach additional details

    61 Have you ever applied for refugee status or protection in any country other than Australia?

    No

    Yes Give details

    In which country?

    Date of application

    Day Month Year

    What was the outcome of your application?

    Name of any international agencies you registered with and dates

    Name of agencyDate

    Day Month Year

    62 Have you ever registered with the United Nations High Commissioner for Refugees (UNHCR)?

    No

    Yes Give details

    Registration number

    Place of registration

    Date of registration

    Day Month Year

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  • 63 Have you ever been assessed for refugee status by the UNHCR?No

    Yes Give details

    Place of assessment

    Date of assessment

    Day Month Year

    Outcome of assessment

    If you are registered and have been assessed by the UNHCR, you will need to complete and attach the UNHCR consent form which provides the Department with consent to speak to the UNHCR about your application.

    The UNHCR consent form is available from the Department’s website www.homeaffairs.gov.au/protectionvisas

    64 Have you previously lived in a refugee camp, centre for refugees or detention centre not in Australia?

    No

    Yes Give details

    Name of camp/centre

    Location

    Name of organisation who ran the camp/centre

    Dates/period spent at camp/centreDay Month Year

    to

    Day Month Year

    65 Are you currently, or have you been, in immigration detention or any other form of custody in Australia?

    No

    Yes Place of detention or custody

    Dates spent in detention or custodyDay Month Year

    to

    Day Month Year

    66 Are you registered with or have you had any contact with the Embassy, High Commission, Consulate or other representatives of any country, including your home country, in Australia?

    No

    Yes Give details

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    http://www.homeaffairs.gov.au/protectionvisas

  • 67 Have you travelled to any country/countries in the last 30 years?You must include all overseas travel undertaken since your first arrival in Australia and any overseas travel undertaken before arriving to Australia.Include: • travel in transit to another country • work or study outside your usual country of residence

    • holiday/leisure trips • business• military deployment • visits back to your own country.

    No

    Yes Give details in chronological order

    Date from Date toReason for visit City/province/country

    Day Month Year Day Month Year

    If insufficient space, attach additional details

    Previous addresses

    68 Give details of all residential addresses where you have lived in the last 20 yearsInclude: • addresses inside and outside Australia • places you resided for study/work

    • refugee camps • any other place you have resided such as share houses, university residences and temporary accommodation.

    Note: Provide your address history in chronological order with no gaps in the timeline. If there are gaps, you must provide an explanation.

    Date from Date to Full residential address (including house number, street name, suburb, town/city, state/province, postcode). Do NOT provide a PO Box

    CountryMonth Year Month Year

    CURRENT

    If insufficient space, attach additional details866 (Design date 09/19) - Page 24 © COMMONWEALTH OF AUSTRALIA, 2019

  • Employment history

    69 Are you currently employed?No

    Yes Give details

    Name and address of employer

    Postcode

    Employer’s telephone number

    ( ) ( )

    Country code Area code Number

    Number of hours of work per week

    70 Are you currently, or have you ever been, employed as an intelligence officer or an agent of an intelligence or security agency?

    No

    Yes Give details

    1. Organisation

    Role

    Dates of employmentDay Month Year

    to

    Day Month Year

    2. Organisation

    Role

    Dates of employmentDay Month Year

    to

    Day Month Year

    If insufficient space, attach additional details

    866 (Design date 09/19) - Page 25© COMMONWEALTH OF AUSTRALIA, 2019

  • 71 Give details of all employment and unemploymentEmployment includes:

    • all paid employment

    • self-employment/family business

    • work experience/internships

    • unpaid employment/volunteer work.

    Unemployment includes:

    • from date of birth up until first employment

    • all gaps/breaks between employment

    • all gaps between education.

    If you are currently retired – write ‘CURRENTLY RETIRED’ in ‘Name of business’ field and provide details in the ‘Your occupation and duties’ field.

    If you have never worked – write your date of birth in the ‘Date from’ field and ‘NEVER WORKED’ in the ‘Name of business/company’ field and provide details in the ‘Your occupation and duties’ field.

    Note: Provide your employment and unemployment history with no gaps in the timeline. If there are gaps, you must provide an explanation.

    Date from Date to Name of business/company (no abbreviations)

    Type of business (eg. government

    Department, bakery)

    Your occupation and dutiesOR

    If unemployed/retired/never worked, provide details of how you occupied your time

    and financially supported yourself

    Full address of business/company (including building number, street name,

    suburb, town/city, state/province) Do NOT provide a PO Box

    Country

    Month Year Month Year

    CURRENT

    If insufficient space, attach additional details

    866 (Design date 09/19) - Page 26 © COMMONWEALTH OF AUSTRALIA, 2019

  • Education

    72 Give details of all education and qualifications since birthEducation/qualification includes:• primary, middle and high school• college/vocational schools• university

    • research/thesis• specialist training• skill/trade qualifications.

    Date from Date to Full name of institution (no abbreviations)

    Full name of course or description of research/ Thesis and supervisor details (no abbreviations) Course status Campus/address of institution Country

    Month Year Month Year

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    Completed

    Withdrew

    Currently enrolled

    If insufficient space, attach additional details© COMMONWEALTH OF AUSTRALIA, 2019 866 (Design date 09/19) - Page 27

  • Convictions, charges, investigations or crimes committed

    73 Details of convictions, charges, investigations or crimes committed:

    Have you been found guilty or convicted of a crime or any offence in any country? No Yes

    Are you aware you are the subject of a criminal investigation or have criminal charges pending against you? No Yes

    Have you committed a serious crime but have not been charged? No Yes

    Have you had any involvement in crimes against humanity (including war crimes and genocide)? No Yes

    If you answered ‘Yes’ to any of the above questions, give details (including all the relevant dates and the country where the crime occurred or where the conviction, charge or investigation took place).

    Crime/Offence Please give details of any crime or offence for which you have been found guilty or been convicted

    Crime/OffenceDate of conviction

    Country Day Month Year

    Criminal investigation Please give details of any criminal investigation you are the subject of that you are aware of

    Reason for investigation Country

    Criminal charges pending Please give details of any criminal charges currently pending against you

    Charge Country

    Involvement in crimes against humanity (including war crimes and genocide)

    Type of involvement Year Country

    Involvement in serious crimes

    Type of involvement Year Country

    866 (Design date 09/19) - Page 28 © COMMONWEALTH OF AUSTRALIA, 2019

  • 74 Are you making your own claims for protection?No Go to Question 84

    Yes

    Your reasons for claiming protection

    This section (Questions 75 to 83) must be completed for applicants making their own claims for protection.

    You must answer all the following questions in your own words.

    You must provide all the details about why you are seeking protection and, wherever possible, you must provide documentation to support your claims.

    A decision may be made on the information provided in your written application and you may not be given another opportunity to present these claims. Therefore, it is important that you include all details relevant to your case and provide any supporting documentation at the time you lodge your protection visa application.

    Your claims for protection will be assessed against relevant Australian law. For further information on Australia’s protection obligations under Australian law, including the definition of a refugee, you should refer to the information on the website www.homeaffairs.gov.au/protectionvisas

    Please be aware that not everybody is entitled to Australia’s protection. You may not engage Australia’s protection obligations even if you have faced harm in the past or you come from a country where there is violence or a lack of security.

    75 I am seeking protection in Australia so that I do not have to return to (name of country or countries that you are able to legally enter and/or reside in. This includes countries you are a citizen or national of or you have a current visa for).

    Give responses to Questions 76 to 83 in relation to all countries you do not wish to or cannot, return to.

    76 Why did you leave that country/those countries? Provide specific details

    If insufficient space, attach additional details

    77 What do you think will happen to you if you return to that country/those countries?

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    http://www.homeaffairs.gov.au/protectionvisas

  • 78 Did you experience harm in that country/those countries?No Go to Question 80

    Yes Give details (including the type of harm you experienced, the person/people responsible for the harm and why they harmed you)

    If insufficient space, attach additional details

    79 Did you seek help within that country/those countries after the harm?No Give reasons for why you did not try to seek help

    If insufficient space, attach additional details

    Yes Give details (including the name of the person/organisation/authorities you asked for help, and if they helped you, what they did)

    If insufficient space, attach additional details

    80 Did you move, or try to move, to another part of that country/those countries to seek safety?No Give reasons for why you did not try to move to another part of that country/those countries

    If insufficient space, attach additional details

    Yes Give details (including where you tried to move, why you were unable to move or where you moved to and what happened)

    If insufficient space, attach additional details

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  • 81 Do you think you will be harmed or mistreated if you return to that country/those countries?No

    Yes Give details (including the type of harm or mistreatment you are likely to experience, the person/people who would be responsible for the harm or mistreatment, why they would harm or mistreat you)

    If insufficient space, attach additional details

    82 Do you think the authorities of that country/those countries can and will protect you if you go back?No Give details about why you think the authorities could not, or would not, protect you

    If insufficient space, attach additional details

    Yes Give details as to which authorities you think would protect you

    83 Do you think you would be able to relocate within that country/those countries to an area where you would not be harmed?No Give details about why you are unable to relocate

    If insufficient space, attach additional details

    Yes Give details as to where you could relocate

    If insufficient space, attach additional details866 (Design date 09/19) - Page 31© COMMONWEALTH OF AUSTRALIA, 2019

  • Documents

    84 Please list all the documents you are required to provide with this application and indicate when you will be providing them. If you cannot provide certain documents, indicate this in the table and provide details at Question 85.

    For example, originals and certified copies of passports, birth certificates, licences, identity documents, evidence of dependency, evidence of change of name.

    If your documents are not in English, please also provide certified English translations of the documents completed by a translator accredited by the National Accreditation Authority for Translators and Interpreters (NAATI).

    Document

    When will you provide this document? (Tick one box for each document)

    With my application

    Will provide later

    Cannot provide

    A

    B

    C

    D

    E

    F

    G

    H

    I

    J

    K

    L

    M

    N

    O

    P

    Q

    R

    S

    If insufficient space, attach additional details

    85 If you cannot provide a document, please indicate which document and explain why

    If insufficient space, attach additional details

    866 (Design date 09/19) - Page 32 © COMMONWEALTH OF AUSTRALIA, 2019

  • Applicant’s declarations86 AUSTRALIAN VALUES STATEMENT

    You must sign this statement if you are aged 18 years or over.

    I confirm that I have read, or had explained to me, information provided by the Australian Government on Australian society and values.

    I understand:

    • Australian society values respect for the freedom and dignity of the individual, freedom of religion, commitment to the rule of law, Parliamentary democracy, equality of men and women and a spirit of egalitarianism that embraces mutual respect, tolerance, fair play and compassion for those in need and pursuit of the public good;

    • Australian society values equality of opportunity for individuals, regardless of their race, religion or ethnic background;

    • the English language, as the national language, is an important unifying element of Australian society.

    I undertake to respect these values of Australian society during my stay in Australia and to obey the laws of Australia.

    I understand that, if I should seek to become an Australian citizen:

    • Australian citizenship is a shared identity, a common bond which unites all Australians while respecting their diversity;

    • Australian citizenship involves reciprocal rights and responsibilities. The responsibilities of Australian citizenship include obeying Australian laws, including those relating to voting at elections and serving on a jury.

    If I meet the legal qualifications for becoming an Australian citizen and my application is approved I understand that I would have to pledge my loyalty to Australia and its people.

    Signature of applicant -

    Date

    Day Month Year

    87 DECLARATIONYou must sign this declaration if you are aged 18 years or over. A parent or legal guardian must sign on behalf of any applicant who is under 15 years of age, or who lacks the legal capacity to sign on their own behalf (applicants who are 15 years of age or older, but have not yet turned 18, may sign for themselves or have a parent or legal guardian sign on their behalf).

    WARNING: Giving false or misleading information is a serious offence. A person who is found to have provided false or misleading information in a visa application may face penalties of AUD210,000, 10 years imprisonment or both. Individuals who provide false or misleading information in relation to the visa applications of 5 or more people face penalties of AUD420,000, 20 years imprisonment or both.

    I declare that:

    • the information I have provided in this application is truthful and honest in every way.

    • the information about me in Part B of this application (including the information in Question 3 of Part B about my character) is complete, correct and up-to-date in every detail.

    • the information I have supplied or caused to be supplied on or with this form is complete, correct and up-to-date in every detail.

    • I understand that if I have given false or misleading information, my application may be refused, and any visa issued may be cancelled.

    • I understand that if this application is approved, any person not included in this application will not have automatic right of entry to Australia because I am the holder of a protection visa.

    • I have read and understood the information supplied to me in this application.

    • in accordance with the Migration Act 1958, I undertake to inform the Department of any changes to my personal circumstances (eg. relationship status, changes to the family composition including the birth of a child and change of name) while my application is being considered.

    • I undertake to inform the Department if I intend to change my address for more than 14 days while my application is being considered.

    • Except as shown in Question 3 of Part B of this application form:

    – I am not aware of any investigation into my affairs that has the potential to lead to criminal charges.

    – I have not been found guilty of, nor had a charge proven against me for, a sexually based offence involving a child.

    – I have not been involved in conduct constituting the crime of genocide, a crime against humanity, a war crime, a crime involving torture or slavery or a crime that is otherwise of serious international concern.

    – to the best of my knowledge I do not have any matters which are either unresolved or in which I have been, or am involved, that would bring into question whether I pass the character test as defined at section 501 of the Migration Act 1958.

    Consent to collect, use and disclose information • I authorise the Australian Government to make any enquiries

    necessary to determine my eligibility for grant of a protection visa in Australia, and to use any information supplied in this application for that purpose.

    • I consent to the Department disclosing my personal information (including sensitive information) to other Australian Government agencies for the purposes of their functions and activities, including (but not limited to) international and diplomatic relations, law enforcement (including the National Police Checking Service) and the administration of Australian Government services and programmes relating to me.

    • I consent to the Department conducting Australian police history checks on my behalf with the Australian Criminal Intelligence Commission (ACIC).

    • I consent to the Department obtaining my personal information from other government agencies that is relevant to this application.

    • I consent to the Department disclosing my personal information to the United Nations. I understand that the United Nations is not subject to the Privacy Act 1988 in relation to the handling of information received from the Department.

    • I consent to the Australian Government disclosing my identifying information for the purpose of making inquiries with the relevant authorities regarding my immigration status in those countries, in which the Australian Government suspects that I may have the right to temporarily or permanently reside in, other than the country/countries I have claimed protection from.

    • I understand the Australian Government may disclose my personal information and/or personal identifiers to countries where I may have the right to temporarily or permanently reside, other than the country/countries I have claimed protection from.

    • I understand that my personal identifiers and my biographical information held by the Department may be given to Australian law enforcement agencies to help identify me, to help determine my eligibility for grant of a protection visa and for law enforcement purposes. I consent to:

    – Australian law enforcement agencies disclosing my personal identifiers and biographical and criminal record information to the Department for any of the purposes outlined above; and

    – the Department using the information obtained for the purposes of the Migration Act 1958 or the Australian Citizenship Act 2007.

    • I have read the information contained in form 1442i Privacy notice.

    • I understand the Department may collect, use and disclose my personal information (including biometric information and other sensitive information) as outlined in form 1442i Privacy notice.

    Signature of applicant -

    Date

    Day Month Year

    866 (Design date 09/19) - Page 33© COMMONWEALTH OF AUSTRALIA, 2019

    ap: name fam: name giv: dob: claims: Offdec dte: valid visa cleared: Offvalid visa: Offprev visa refused: Offprotection visa cancel: Offpreg: Offage: exp dob: birth town: birth state: birth cntry: citizenship birth: dob diff dte: citizenship current dte: stateless: citizenship current: citizenship father: citizenship mother: cit other: Offcit dtl 2: cit cntry oth 2: cit dtl 1: cit cntry oth 1: dob 4: entr reside: Offentr reside cntry 1: entr reside cntry dtl 1: entr reside cntry 2: entr reside cntry dtl 2: income: Offincome dtl: army: Offarmy from dte 1: army to dte 1: army cntry 1: army duties 1: army dtl 1: army cntry dep 1: army from dte 2: army to dte 2: army cntry 2: army duties 2: army dtl 2: army cntry dep 2: army dtl: army obligations: Offmarital engaged: Offmarital never mar: Offmarital married: Offmarital dim: marital place 1: marital de facto: Offmarital drb: marital place 3: marital separ: Offdefacto drb: married drb: married dom: married place: sep dom: marital divorced: Offdiv dod: sep place: marital widowed: Offdiv drb: div dom: wid drb: und 18: Offdiv place: wid dow: custody name 1: custody dob 1: custody name 2: custody dob 2: custody name 3: custody dob 3: custody name 4: custody dob 4: custody name 5: custody dob 5: custody name 6: custody dob 6: sep drb: rel contact: Offrel contact dtl: aus cont: Offaus cont sex 1: Offaus cont fam 1: aus cont giv 1: aus cont rel 1: aus cont dob 1: aus cont tcob 1: aus cont rob 1: aus cont cob 1: aus cont nat 1: aus cont add 1: aus add sub 1: aus add state 1: aus add pc 1: aus cont ac 1: aus cont pn 1: aus cont mob 1: aus cont email 1: aus cont fam 2: aus cont sex 2: Offaus cont rel 2: aus cont dob 2: aus cont tcob 2: aus cont rob 2: aus cont cob 2: aus cont nat 2: aus cont add 2: aus add state 2: aus add pc 2: aus cont ac 2: aus cont pn 2: aus cont mob 2: aus cont email 2: aus add sub 2: trav doa: trav place dep: trav place arrive: trav dod: leave hc: Offarrive illegal dtl: trav aus visitor: Offtrav aus trans pass: Offtrav aus stud: Offtrav aus migr: Offtrav aus ship deserter: Offtrav aus stowaway: Offtrav aus unauth: Offtrav aus unauth air: Offtrav aus oth: Offtrav other: entre aus doc: Offdoc type 1: doc no 1: doc coi 1: doc doi 1: doc doe 1: doc place 1: doc none dtl: cur travel doc: Offenter aus doc: Offdoc no 3: doc coi 3: doc name 3: doc doe 3: doc place 3: doc none dtl 3: cur travel doc valid: Offcur travel doc valid dtl: cur travel obtain dtl: doc doi 3: ext dte from: ext dte to: doc type 3: ext cntry: cur travel doc oth: Offdoc type 2: doc no 2: doc coi 2: doc name 2: doc doi 2: doc doe 2: doc place 2: doc doi 4: doc doe 4: doc place 4: doc where 4: cur travel doc oth 2: Offdoc type 4: doc no 4: doc coi 4: doc name 4: doc where 2: doc no 5: doc coi 5: doc name 5: doc type 5: health exam: Offhealth exam dtl: doc where 5: emp: Offemp name: emp str: emp str ln2: emp sub: emp hap: emp std: emp sn: emp pn: job hrs: emp intelligence: Offemp inteligence role 1: emp inteligence org 1: emp inteligence fr 1: emp inteligence to 1: emp inteligence org 2: emp inteligence role 2: emp inteligence fr 2: emp inteligence to 2: emp fr 1: emp name 1: emp bs 1: emp duties 1: emp add 1: emp cntry 1: emp fr 2: emp to 2: emp name 2: emp bs 2: emp duties 2: emp add 2: emp cntry 2: emp fr 3: emp to 3: emp name 3: emp bs 3: emp duties 3: emp add 3: emp cntry 3: emp fr 4: emp to 4: emp name 4: emp bs 4: emp duties 4: emp add 4: emp cntry 4: emp fr 5: emp to 5: emp name 5: emp bs 5: emp duties 5: emp add 5: emp cntry 5: qual fr 1: qual to 1: qual name 1: qual course 1: qual: Offqual campus add 1: qual country 1: qual fr 2: qual to 2: qual name 2: qual course 2: qual 2: Offqual campus add 2: qual country 2: qual fr 3: qual to 3: qual name 3: qual course 3: qual 3: Offqual campus add 3: qual country 3: qual fr 4: qual to 4: qual name 4: qual course 4: qual 4: Offqual campus add 4: qual country 4: qual fr 5: qual to 5: qual name 5: qual course 5: qual 5: Offqual campus add 5: qual country 5: qual fr 6: qual to 6: qual name 6: qual course 6: qual 6: Offqual campus add 6: qual country 6: qual fr 7: qual to 7: qual name 7: qual course 7: qual 7: Offqual campus add 7: qual country 7: qual fr 8: qual to 8: qual name 8: qual course 8: qual 8: Offqual campus add 8: qual country 8: conviction: Offinvestigation: Offconvicetd crime: Offhumanity crime: Offcrime 1: crime doc 1: crime cntry 1: crime 2: crime doc 2: crime cntry 2: crime 3: crime doc 3: crime cntry 3: crime 4: crime doc 4: crime cntry 4: invest 1: invest cntry 1: invest 2: invest cntry 2: invest 3: invest cntry 3: charge 1: charge cntry 1: charge 2: charge cntry 2: charge 3: charge cntry 3: war crime 1: war crime yr 1: war crime cntry 1: war crime 2: war crime yr 2: war crime cntry 2: war crime 3: war crime yr 3: war crime cntry 3: serious crime 1: serious crime yr 1: serious crime cntry 1: serious crime 2: serious crime yr 2: serious crime cntry 2: serious crime 3: serious crime yr 3: serious crime cntry 3: claim protection: Offref protect: cntry dtl: go back dtl: harm: Offharm help: Offmove: Offmove no help dtl: move help dtl: harm dtl: harm return: Offharm return dtl: harm no help dtl: harm help dtl: protect: Offprotect no dtl: protect dtl: relocate: Offrelocate no dtl: relocate dtl: dec name: doc A: A provide: Offdoc B: B provide: Offdoc C: C provide: Offdoc D: D provide: Offdoc E: E provide: Offdoc F: F provide: Offdoc G: G provide: Offdoc H: H provide: Offdoc I: I provide: Offdoc J: J provide: Offdoc K: K provide: Offdoc L: L provide: Offdoc M: M provide: Offdoc N: N provide: Offdoc O: O provide: Offdoc P: P provide: Offdoc Q: Q provide: Offdoc R: R provide: Offdoc S: S provide: Offcannot doc 1: cannot doc exp 1: cannot doc 2: cannot doc exp 2: cannot doc 3: cannot doc exp 3: cannot doc 4: cannot doc exp 4: cannot doc 5: cannot doc exp 5: cannot doc 6: cannot doc exp 6: cannot doc 7: cannot doc exp 7: aus cont giv 2: dob diff: Offcur travel doc ext: Offch offence: Offch crime: Offch interpol: Offch sex offence: Offch sex reg: Offch acq: Offch left: Offch sec: Offch war: Offch crim org: Offch violent org: Offch mil: Offch train: Offch smug: Offch dep: Offch overstay: Offch debt: Offch 11: ch dtl 11: ch 12: ch dtl 12: check1: Offcheck2: Offcheck3: Offcheck4: Offcheck5: Offcheck6: Offcheck7: Offcheck8: Offcheck9: Offcheck10: Offcheck11: Offcheck12: Offcheck13: Offcheck14: Offcheck15: Offcheck15a: Offcheck16: Offcheck17: Offcheck18: Offcheck19: Offcheck20: Offcheck21: Offvalues dec 1: dec: visit oth country: Offvisit oth doa 1: visit oth dod 1: visit oth country reason 1: visit oth country 1: visit oth doa 2: visit oth dod 2: visit oth country reason 2: visit oth country 2: visit oth doa 3: visit oth dod 3: visit oth country reason 3: visit oth country 3: visit oth doa 4: visit oth dod 4: visit oth country reason 4: visit oth country 4: visit oth doa 5: visit oth dod 5: visit oth country reason 5: visit oth country 5: visit oth doa 6: visit oth dod 6: visit oth country reason 6: visit oth country 6: visit oth doa 7: visit oth dod 7: visit oth country reason 7: visit oth country 7: visit oth doa 8: visit oth dod 8: visit oth country reason 8: visit oth country 8: visit oth doa 9: visit oth dod 9: visit oth country reason 9: visit oth country 9: visit oth doa 10: visit oth dod 10: visit oth country reason 10: visit oth country 10: visit oth doa 11: visit oth dod 11: visit oth country reason 11: visit oth country 11: visit oth doa 12: visit oth dod 12: visit oth country reason 12: visit oth country 12: addr fr 1: address live 1: cntry lived 1: addr fr 2: addr to 2: address live 2: cntry lived 2: addr fr 3: addr to 3: address live 3: cntry lived 3: addr fr 4: addr to 4: address live 4: cntry lived 4: addr fr 5: addr to 5: address live 5: cntry lived 5: addr fr 6: addr to 6: address live 6: cntry lived 6: addr fr 7: addr to 7: address live 7: cntry lived 7: addr fr 8: addr to 8: address live 8: cntry lived 8: addr fr 9: addr to 9: address live 9: cntry lived 9: ccc pas: Offccc pas dtl: name fam C: name giv C: no: oth name: Offname type C: name fam change C: name giv change C: name change dtl C: russian: Offrussian dtl: boat no: sex 4: Offcit other 2: Offcit cntry oth 3: cit dtl 3: cit oth dte from: cit oth dte to: cit ref 1: Offcit ref dte 1: cit ref cntry 1: cit ref circs 1: cit ref dte 2: cit ref cntry 2: cit ref circs 2: service: Offservice 2: Offlang 1: lang sp 1: Offlang re 1: Offlang wr 1: Offlang 2: lang sp 2: Offlang re 2: Offlang wr 2: Offlang 3: lang sp 3: Offlang re 3: Offlang wr 3: Offitv ip: Offip lang dtl: itv factors: Offfactors dtl: eth grp: relig: occupation: resi str 4: resi sub 4: resi cntry 4: resi hap 4: corresp str: corresp sub: corresp cntry: corresp hap: office sn: office pn: after sn: after pn: mob ph: email: Offemail dtl: com dimia: Offemail 2: mig cntry: Offmig cntry dtl: mig doa: mig app: mig app reason dtl: mig app dtl: visa ref: Offvisa ref dte 1: visa ref cntry 1: visa ref dtl 1: visa ref dte 2: visa ref cntry 2: visa ref dtl 2: rem cntry: Offrem cntry dte 1: rem cntry 1: rem cntry dtl 1: rem cntry dte 2: rem cntry 2: rem cntry dtl 2: ref status: Offref status cntry: ref status dte: ref status dtl: ref status agency 1: ref status agency dte 1: ref status agency 2: ref status agency dte 2: ref status agency 3: ref status agency dte 3: ref unhcr: Offref unhcr num: ref unhcr place: ref unhcr dte: ass unhcr: Offass unhcr place: ass unhcr dte: ass unhcr dtl: ref camp: Offref camp name: ref camp location: ref camp org: ref camp from: ref camp to: detention: Offdetention place: detention from: detention to: nat cntry: Offnat cntry dtl: help: Offhelp title: Offhelp title other: help name fam: help name giv: help resi str: help resi sub: help resi cntry: help resi hap: help office cc: help office ac: help office pn: help mob: help mg reg: Offhelp mg aust: Offhelp pay: Offcom receive: Offpayment receipt no: int assist: Offinterp full name: interp ad str: interp ad sub: interp ad cntry: interp ad PC: interp number: interp agency: int read: Offch 13: ch dtl 13: ch 14: ch dtl 14: ch 15: ch dtl 15: ch 16: ch dtl 16: ch 17: ch dtl 17: ch 18: ch dtl 18: ch 19: ch dtl 19: ch 20: ch dtl 20: ch 21: ch dtl 21: ch 22: ch dtl 22: ch 23: ch dtl 23: ch 24: ch dtl 24: ch 25: ch dtl 25: ch 26: ch dtl 26: ch 27: ch dtl 27: ch 28: ch dtl 28: ch 29: ch dtl 29: ch 30: ch dtl 30: ch 1: ch dtl 1: ch 2: ch dtl 2: ch 3: ch dtl 3: ch 4: ch dtl 4: ch 5: ch dtl 5: ch 6: ch dtl 6: ch 7: ch dtl 7: ch 8: ch dtl 8: ch 9: ch dtl 9: ch 10: ch dtl 10: ch 31: ch dtl 31: ch 32: ch dtl 32: ch 33: ch dtl 33: ch 34: ch dtl 34: ch 35: ch dtl 35: ch 36: ch dtl 36: ch 37: ch dtl 37: ch 38: ch dtl 38: ch 39: ch dtl 39: ch 40: ch dtl 40: ch 41: ch dtl 41:

    m2: name fam: name giv: dob: rel ap: claims: Off

    m3: name fam: name giv: dob: rel ap: claims: Off

    m4: name fam: name giv: dob: rel ap: claims: Off

    m5: name fam: name giv: dob: rel ap: claims: Off

    m6: name fam: name giv: dob: rel ap: claims: Off

    m7: name fam: name giv: dob: rel ap: claims: Off

    m8: name fam: name giv: dob: rel ap:

    m1: claims: Off

    fm: not fam 5: not giv 5: dob 5: not sex 5: Offnot pob 5: not cit 5: not marital mar 5: Offnot marital sep 5: Offnot marital never 5: Offnot marital eng 5: Offnot marital div 5: Offnot marital de facto 5: Offnot marital wid 5: Offnot rel to app 5: not mob 5: not ac 5: not pn 5: not email 5: in Aus cntry 5: in Aus 5: Offin Aus dtl 5: not fam 6: not giv 6: dob 6: not pob 6: not cit 6: not marital mar 6: Offnot marital sep 6: Offnot marital never 6: Offnot marital eng 6: Offnot marital div 6: Offnot marital de facto 6: Offnot marital wid 6: Offnot rel to app 6: not mob 6: not ac 6: not pn 6: not email 6: in Aus cntry 6: in Aus 6: Offin Aus dtl 6: not sex 6: Offnot fam 3: not giv 3: dob 3: not sex 3: Offnot pob 3: not cit 3: not marital mar 3: Offnot marital sep 3: Offnot marital never 3: Offnot marital eng 3: Offnot marital div 3: Offnot marital de facto 3: Offnot marital wid 3: Offnot rel to app 3: not mob 3: not ac 3: not pn 3: not email 3: in Aus cntry 3: in Aus 3: Offin Aus dtl 3: not fam 4: not giv 4: dob 4: not sex 4: Offnot pob 4: not cit 4: not marital mar 4: Offnot marital sep 4: Offnot marital never 4: Offnot marital eng 4: Offnot marital div 4: Offnot marital de facto 4: Offnot marital wid 4: Offnot rel to app 4: not mob 4: not ac 4: not pn 4: not email 4: in Aus cntry 4: in Aus 4: Offin Aus dtl 4: not app: Offnot fam 1: not giv 1: dob 1: not sex 1: Offnot pob 1: not cit 1: not marital mar 1: Offnot marital sep 1: Offnot marital never 1: Offnot marital eng 1: Offnot marital div 1: Offnot marital de facto 1: Offnot marital wid 1: Offnot rel to app 1: not mob 1: not ac 1: not pn 1: not email 1: in Aus cntry 1: in Aus 1: Offin Aus dtl 1: not fam 2: not giv 2: dob 2: not sex 2: Offnot pob 2: not cit 2: not marital mar 2: Offnot marital sep 2: Offnot marital never 2: Offnot marital eng 2: Offnot marital div 2: Offnot marital de facto 2: Offnot marital wid 2: Offnot rel to app 2: not mob 2: not ac 2: not pn 2: not email 2: in Aus cntry 2: in Aus 2: Offin Aus dtl 2:

    cr: sex 1: Offsex 2: Offsex 3: Offsex 4: Offsex 5: Offsex 6: Offsex 7: Offsex 8: Offsex 9: Offsex 10: Offrel to app 2: nam fam 2: nam giv 2: nam oth 2: dob 2: ccc 2: pob 2: citzn2: cor 2: rel to app 3: nam fam 3: nam giv 3: nam oth 3: dob 3: ccc 3: pob 3: citzn3: cor 3: rel to app 4: nam fam 4: nam giv 4: nam oth 4: dob 4: ccc 4: pob 4: citzn4: cor 4: rel to app 5: nam fam 5: nam giv 5: nam oth 5: dob 5: ccc 5: pob 5: citzn5: cor 5: rel to app 6: nam fam 6: nam giv 6: nam oth 6: dob 6: ccc 6: pob 6: citzn6: cor 6: rel to app 7: nam fam 7: nam giv 7: dob 7: ccc 7: pob 7: citzn7: cor 7: rel to app 8: nam fam 8: nam giv 8: dob 8: ccc 8: pob 8: citzn8: cor 8: rel to app 9: nam fam 9: nam giv 9: dob 9: ccc 9: pob 9: citzn9: sex 11: Offrel to app 12: nam fam 12: nam giv 12: nam oth 12: sex 12: Offdob 12: ccc 12: pob 12: citzn12: cor 12: rel to app 13: nam fam 13: nam giv 13: nam oth 13: sex 13: Offdob 13: ccc 13: pob 13: citzn13: cor 13: rel to app 14: nam fam 14: nam giv 14: nam oth 14: sex 14: Offdob 14: ccc 14: pob 14: citzn14: cor 14: rel to app 15: nam fam 15: nam giv 15: nam oth 15: sex 15: Offdob 15: ccc 15: pob 15: citzn15: cor 15: rel to app 16: nam fam 16: nam giv 16: nam oth 16: sex 16: Offdob 16: ccc 16: pob 16: citzn16: rel to app 17: nam fam 17: nam giv 17: nam oth 17: sex 17: Offdob 17: ccc 17: pob 17: citzn17: rel to app 18: nam fam 18: nam giv 18: nam oth 18: sex 18: Offdob 18: ccc 18: pob 18: citzn18: cor 18: rel to app 19: nam fam 19: nam giv 19: nam oth 19: sex 19: Offdob 19: ccc 19: pob 19: citzn19: cor 19: sex 20: Offcor 16: cor 17: nam oth 7: nam oth 8: nam oth 9: cor 9: rel to app 20: nam fam 20: nam giv 20: nam oth 20: dob 20: ccc 20: pob 20: citzn20: cor 20: rel to app 21: nam fam 21: nam giv 21: nam oth 21: sex 21: Offdob 21: ccc 21: pob 21: citzn21: cor 21: rel to app 22